摘要
目的探讨腹腔镜修补术治疗胃和十二指肠溃疡穿孔的临床效果及对患者免疫功能的影响。方法选择2010年2月至2017年2月郑州市第二人民医院收治的胃和十二指肠溃疡穿孔患者98例为研究对象,根据手术方法分为观察组和对照组,每组49例。对照组患者行开腹修补术,观察组患者行腹腔镜修补术。记录2组患者的手术时间、术中出血量、肛门排气时间及住院时间;所有患者于术后1、2、7 d采用视觉模拟评分法(VAS)进行术后疼痛程度评分;分别于术前30 min及术后1、2、7 d测定血清降钙素原(PCT)、CD_3^+、CD_4^+、CD_8^+及自然杀伤(NK)细胞水平。结果观察组患者术中出血量显著少于对照组(P<0.05),肛门排气时间、住院时间显著短于对照组(P<0.05),但手术时间长于对照组(P<0.05)。观察组患者术后1、2、7 d疼痛VAS评分显著低于对照组(P<0.05)。观察组和对照组患者术后并发症发生率分别为6.12%(3/49)、26.53%(13/49),观察组患者术后并发症发生率显著低于对照组(χ~2=13.652,P<0.05)。术前2组患者血清CD_3^+、CD_4^+、CD_8^+、NK细胞及PCT水平比较差异均无统计学意义(P>0.05)。对照组患者术后1、2 d血清CD_3^+、CD_4^+、CD_8^+、NK细胞水平显著低于术前,PCT水平显著高于术前(P<0.05);对照组患者术后7 d血清CD3+、CD8+、NK细胞水平显著低于术前(P<0.05);对照组患者术后7 d血清CD4+、PCT水平与术前比较差异均无统计学意义(P>0.05)。观察组患者术后1 d血清CD_3^+、CD_4^+、CD_8^+、NK细胞水平显著低于术前,PCT水平显著高于术前(P<0.05);观察组患者术后2、7 d血清CD_3^+、CD_4^+、CD_8^+、NK细胞及PCT水平与术前比较差异均无统计学意义(P>0.05)。术后1、2、7 d,观察组患者血清CD_3^+、CD_4^+、CD_8^+、NK细胞水平显著高于对照组(P<0.05);术后1、2 d,观察组患者血清PCT水平显著低于对照组(P<0.05);2组患者术后7 d血清PCT水平比较差异无统计学意义(P>0.05)。结论腹腔镜修补术治疗胃和十二指肠溃疡穿孔创伤小,对机体的免疫功能影响较小,有利于术后患者机体功能恢复,减少术后并发症。
Objective To investigate the effect of laparoscopic neoplasty in the treatment of gastric and duodenal ulcer perforation and its influence on immune function. Methods A total of 98 patients with gastric and duodenal ulcer perforation were selected from February 2010 to February 2017 in the Second People＇s Hospital of Zhengzhou City. The patients were divided into observation group and control group according to operative method,49 cases in each group. The operation time,intraoperative bleeding volume,anal exhaust time and hospitalization time were recorded in the two groups. The postoperative pain of all patients were evaluated by visual analogue scales（VAS） on the 1 st,2 ndand 7 thday after operation. The levels of serum procalcitonin（PCT）,CD3＋,CD4＋,CD8＋and natural killer（NK） cell were detected at the time points of 30 min before operation and the 1 st,2 ndand 7 thday after operation respectively. Results The intraoperative bleeding volume in the observation group was significantly less than that in the control group（P〈0. 05）,the anus exhaust time and the hospitalization time in the observation group were significantly shorter than those in the control group（P〈0. 05）,and the operation time in the observation group was significantly longer than that in the control group（P〈0. 05）. The VAS score in the observation group was significantly lower than those in the control group on the 1 st,2 ndand 7 thday after operation（P〈0. 05）. The incidence of postoperative complication in the observation group and the control group was 6. 12%（3/49） and 26. 53%（13/49） respectively,the incidence of postoperative complication in the observation group was significantly lower than that in the control group（χ2=13. 652,P〈0. 05）. There was no significant difference in serum CD3＋,CD4＋,CD8＋,NK cell and PCT levels between the two groups before operation（P〈0. 05）. The levels of serum CD3＋,CD4＋,CD8＋and NK cell on the 1 stand 2 ndday after operation were significantly lower than those before operation,and the PCT level on the 1 stand 2 ndday after operation was significantly higher than that before operation in the control group（P〈0. 05）. The levels of serum CD3＋,CD8＋and NK cell on the 7 thday after operation were significantly lower than those before operation in the control group（P〈0. 05）. There was no significant difference in the levels of serum CD4＋and PCT between the 7 thday after operation and before operation in the control group（P〈0. 05）. The levels of serum CD3＋,CD4＋,CD8＋and NK cell on the 1 stday after operation were significantly lower than those before operation,and the PCT level on the 1 stday after operation was significantly higher than that before operation in the observation group（P〈0. 05）. There was no significant difference in serum CD3＋,CD4＋,CD8＋,NK cell and PCT levels between the 2 nd,7 thday after operation and before operation in the observation group（P〈0. 05）. The levels of serum CD3＋,CD4＋,CD8＋and NK cell in the observation group were significantly higher than those in the control group on the 1 st,2 ndand7 thday after operation（P〈0. 05）. The serum PCT level in the observation group was significantly lower than that in the control group on the 1 stand 2 ndday after operation（P〈0. 05）. There was no significant difference in serum PCT level between the two groups on the 7 thday after operation（P〈0. 05）. Conclusion Laparoscopic neoplasty for gastric and duodenal ulcer perforation has less traumatic and less influence on the immune function of patients. It is beneficial to the recovery of postoperative body function,and can reduce postoperative complications. The laparoscopic repair is effective in the treatment of perforation of gastric and duodenal ulcer. It is beneficial to the recovery of reduce postoperative complications.
作者
马力
MA Li(Department of General Surgery, the Second People＇ s Hospital of Zhengzhou City Affiliated to Jinan University, Zhengzhou 450006 ,Henan Province, Chin)
出处
《新乡医学院学报》
CAS
2018年第6期509-512,共4页
Journal of Xinxiang Medical University
